Clinical Review

Management of kidney stones

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39113.480185.80 (Published 01 March 2007) Cite this as: BMJ 2007;334:468
  1. Nicole L Miller, fellow in endourology and minimally invasive surgery,
  2. James E Lingeman, physician and surgeon
  1. Methodist Hospital Institute for Kidney Stone Disease, Indiana University School of Medicine, and International Kidney Stone Institute, Indianapolis, IN 46202, USA
  1. Correspondence to: J E Lingeman jlingeman{at}clarian.org

    Urolithiasis affects 5-15% of the population worldwide.1 w1 Recurrence rates are close to 50%,2 w2 and the cost of urolithiasis to individuals and society is high. Acute renal colic is a common presentation in general practice, so a basic understanding of its evaluation and treatment would be useful. Most of the literature is retrospective, but we will try to provide an evidence based review of the management of urolithiasis and will cite prospective randomised controlled trials when available.

    Summary points

    • Unenhanced helical computed tomography is the best radiographic technique for diagnosing urolithiasis

    • Shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy have replaced open surgery for treating urolithiasis

    • Most simple renal calculi (80-85%) can be treated with shock wave lithotripsy

    • Percutaneous nephrolithotomy is the treatment of choice for complex renal calculi

    • Staghorn calculi should be treated, and percutaneous nephrolithotomy is the preferred treatment in most patients

    • Ureteroscopy is the preferred treatment in pregnant, morbidly obese, or patients with coagulopathy

    • Most ureteral calculi <5 mm in diameter will pass spontaneously within four weeks of the onset of symptoms

    Sources and selection criteria

    • We performed a literature search to identify information on the management of urolithiasis

    • We searched databases including Medline and the Cochrane Library to assemble appropriate evidence based reference material

    What is the clinical presentation and initial evaluation?

    Initial evaluation of the patient with urolithiasis should include a complete medical history and physical examination. Typical symptoms of acute renal colic are intermittent colicky flank pain that may radiate to the lower abdomen or groin, often associated with nausea and vomiting.3 Lower urinary tract symptoms such as dysuria, urgency, and frequency may occur once a stone enters the ureter.

    Comorbid diseases should be identified, particularly any systemic illnesses that might increase the risk of kidney stone formation or that might influence the clinical course of the disease (box 1). Other important features are a …

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